Preventing FRUTI (Foley Related Urinary Tract Infection) in LTACH - page 2

by maggiejrn 22,144 Views | 29 Comments

While working as the Quality Manager for a LTACH (Long Term Acute Care Hospital) one of my responsibilities was Infection Control. As with most facilities our highest number of infections were FRUTI (Foley Related Urinary Tract... Read More


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    I think that this may be a huge asset to the nursing profession!

    Evidence based practice is so important to our profession.

    Is there a way you can provide with data, maybe write it into an article for submission?

    Guys the whole idea here is not to reward the staff (which is demeaning, sorry) but to educate us on how to decrease urinary tract infections!!

    I think you did an amazing job.
    The only thing I would want to see is some graphics, data....to show that this decreased the risks of infections.

    Keep going with your ideas! I believe in positivity too! If we all keep looking at the negatives then we are not empowerd to change and help our profession, which needs more change.

    Nurses are at the bedsides way more than MD's, patients families, CDC, and other entities. It is up to us to make positive changes for our patients. Even if it is one patient at a time.

    -side note: we would get tickets for ice cream if we did a good job on our unit. The funny thing was that no one had time to get an ice cream to eat it. Plus who wants to eat an ice cream when we dont even have the time to eat lunch.
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    I'm glad you chose the route of rewarding desirable behavior, as nurses are all too often told that the reason patients have complications is that we're lazy/not doing things right/not vigilant enough. LTACHs are a notoriously busy and difficult setting in which to give care, and my hat's off to anyone who can do well there and still committed to making it better, rather than becoming jaded like so many do.

    Does anybody have suggestions on better incontinence management for women? For men, we can give them a pee bottle or put on a Texas catheter if incontinence is the problem. With women, there is no good way to keep urine off the skin. Even for my ladies that can use a bed pan, after a day or so they frequently start showing signs of breakdown from the rims of the pan or excoriation from urine touching the skin. Barrier creams can help, but become a problem when the patient moves her bowels and the cream becomes contaminated but is still difficult to remove from the skin.

    Potty chairs can help, but it takes a long time to get one from central. I've had patients who waited for days for one to become available. I've even had them show up two hours after I transferred the patient upstairs! And my intubated ones cannot get up to use them until they get extubated or trached.
    Last edit by ShyViolet on Sep 15, '09 : Reason: to avoid someone stating the obvious
    deskbarn likes this.
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    I am glad to hear you advocate the use of alcohol wipes on the drain of the foley. Working as an LNA, it was how I was trained by my teacher. But it is not what I have found out in the real world. I had a couple of people question me on the need to use alcohol wipes. As far as the bag laying on the floor, that happens a lot and I appreciate your suggestions to end that. It never crossed my mind as an issue since it is what I have seen as practice on the floor as an LNA and a student nurse. Thanks for sharing and keeping us all up to snuff.
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    I am a QI nurse in home health and am looking at improving this outcome in our 2010 project year. It is a tough outcome. Glad to hear you had results, and your ideas are good ones. Thanks for sharing. Long term foleys are an endless source of frustration for all of us, and the poor patient who has recurrent UTIs must suffer terribly. I often see staff plop the bag on the patient's lap when transferring from chair to bed, etc. Especially in PCH settings. I think teaching the staff in these facilities will definitely be a part of my plan. Your patients are lucky that you are so motivated. Great work!

    BTW we have been suggesting patients keep the bag in their hospital plastic basin or a clean bucket for ages. At home there is no one to keep an eye on them and they often end up leaking since the caths and bags are only changed monthly. Home beds also have no siderails usually, so they either jerry rig (sp?) a hanger, or hook them on the footboard post (hard to reach). Hence the basin.
    Last edit by nursemarion on Sep 16, '09
    deskbarn likes this.
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    Is there a non-offensive way to re-teach and reevaluate how experienced nurses place foley catheters? On occasion I just happen to be at a bedside when another RN is placing a foley...and am appalled at their technique, or lack thereof! They often have poor exposure of the urethra, often contaminate the area by relaxing their "exposing" fingertips between each betadine wipe, and let go of the labia when advancing the catheter thereby contaminating the catheter.

    I have to work closely with these folks, and I am FAR from a perfect nurse... BUT I have very, very meticulous about my catheter insertion technique.

    Any hints?
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    maggie

    Thanks, for this information. I am the nurse educator for a LTACH facility. What a wonderful idea to empower staff in helping to prevent FRUTI. I am going to pass this information to our infection control nurse as well. We use the Low Boy beds for our high fall risk patients also. It is a challenge to prevent FRUTIs. I applaud your efforts and keep up the good work.

    Wen-Wen
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    Quote from HazeKomp
    Is there a non-offensive way to re-teach and reevaluate how experienced nurses place foley catheters? On occasion I just happen to be at a bedside when another RN is placing a foley...and am appalled at their technique, or lack thereof! They often have poor exposure of the urethra, often contaminate the area by relaxing their "exposing" fingertips between each betadine wipe, and let go of the labia when advancing the catheter thereby contaminating the catheter.

    I have to work closely with these folks, and I am FAR from a perfect nurse... BUT I have very, very meticulous about my catheter insertion technique.

    Any hints?
    If you are a staff nurse, you must involve infection control in this. If it comes from you they will see you as a threat and a know it all. I suggest a general review of the techniques for everybody - maybe a video from the local nursing school or something? I am sure there is information out there. Then, have the staff do competency testing. It is going to be offensive no matter what but we all forget things and need a review sometimes. If it comes from the infection control dept. as a "project" it will be better accepted. In the name of QI or education nurses will at least understand why.
    deskbarn likes this.
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    Great idea to share maggiejrn. Kudos given
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    I was a Special Education teacher who used motivators like tickets/trinkets for my students with mental retardation and Autism. I think a better buy in would be evidence based education presented @ informal in services with ceu units offered for CNA's. Skip the tickets and treat the CNA's and your peers like the health professionals they are.
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    Thanks you, great article. We were having the same problems with the Foley bag touching the floor when the bed was in the lowest position also. What I had maintenance apply was hooks on the foot boards, which maintained the gravity for drainage and kept the Foley bags off the floors. We used the 3M self adhesive hooks. It was your article that inspired this. Thanks
    deskbarn likes this.


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